Need for free clinics to continue

JANESVILLE—Leaders of free health clinics that serve patients in Rock and Walworth counties agree their services will still be necessary even with the expansion of insurance coverage through the Affordable Care Act.

“There will continue to be many people in need in our community of the service we provide,” said Jean Randles, executive director of HealthNet of Rock County.

Dr. Katherine R. Gaulke, clinic ambassador of Open Arms Free Clinic in Elkhorn and chairwoman of the Walworth County Affordable Care Act Awareness Steering Committee, agreed: “I can say free clinics are not in limbo.”

“We had a Wisconsin Free Clinic meeting Jan. 13, discussed this and have a good understanding of who our future target population will be post-ACA and post Wisconsin Badgercare/HIRSP (Health Insurance Risk-Sharing Plan) changes April 1,” she said.

Some groups still will be uninsured in the future, Gaulke and Randles said, including:

-- People with exemption waivers who have experienced hardships that keep them from getting health coverage.

-- Undocumented immigrants.

-- Incarcerated individuals and those recently released from court-ordered work release programs.

-- People who missed the enrollment period; healthcare.gov enrollment ends March 31

-- People who lose their subsidized insurance coverage during 2014 because they didn't pay their premiums.

-- People with pending benefits or waiting for benefits to start.

-- People who believe health insurance through healthcare.gov or their employer is unaffordable without an exemption waiver

-- Native Americans who have the exchange opportunity but do not have to be covered under the Affordable Care Act.

“Hardship waivers and ACA waivers are going to play a major role in who remains uninsured,” Gaulke said.

Randles agreed: “Individuals that cannot afford premiums, deductibles and co-pays will be required to complete a hardship waiver and will not be required to enroll in affordable health care.”

Thefree clinics also anticipate they will serve these insured people this year:

-- Individuals with inadequate coverage that, for example, does not cover at least 60 percent of allowed medical costs.

-- People put on waiting lists by providers when primary care physicians are not accepting new patients.

Currently, HealthNet sees 1,300 patients a year. Randles thinks that number will change with the demographics of the people it serves.

“I expect HealthNet will still remain busy, but I would say there's going to be a different population—people who maybe did qualify for BadgerCare in the past and now no longer will,'' she said.

The change in HealthNet patients started at the beginning of this calendar year.

“Some of our current patients are no longer eligible for HealthNet because they've gone on marketplace.gov for affordable health care and they've started to enroll,” Randles said.

“There's a lot of people still not understanding their responsibility and knowledge of the Affordable Care Act enrollment process,” she said.

Gaulke said the Open Arms clinic census of 600 patients a year will increase because so much attention is being focused on getting insurance and figuring out how to address health care needs.

“There will still be so many adults without insurance, including patients losing BadgerCare, who are still finding insurance unaffordable and then are learning about the free clinic,” she said.

“We've been encouraging people to go to the marketplace to get insurance, so we've seen some patients already get their health insurance and move into the private market. But April will be a big month of change because BadgerCare will now be available to people who were on wait lists,” Gaulke said.

“I don't think the public has an understanding of the gaps that will continue to exist in the U.S. health care system,” Gaulke said.

Randles agreed: “That's why there will be the need for free clinics to exist.''

“My understanding is in Massachusetts where the Affordable Care Act is copied from, there are more free clinics now than there were prior to affordable health care,” she said.